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ELECTRICAL PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 i5 <br /> 425-257-8810 - FAX 425-257.8857 —www.everettwa.o g <br /> L IyIZ-l7i <br /> N/ 0 ST S . w_SurTE F <br /> PROJECT ADDRESS <br /> jOeS 2/4C.rAdr fwd uL 1CTE y2s ?lam-�63 <br /> Owner Mall Address Cty State/Zip Phone <br /> Tenant Mail Address City Slate/Zip L42_r- Phone <br /> -1S2 -- <br /> 1 C TwC ,o. f3a�2)17 L'XA A-. L.�-r2, 1194?e' 7s- . <br /> L <br /> � !Z E L�GT/tt' C Y <br /> Electrical Contractor Mad Address City Seale2ip Phone <br /> )C) -j IL L- h >: 5 7o IT )-t O Lt 0 ) S! <br /> State License Number(required) City oerett Business License Number(required) <br /> 1,-9 S ZOO . L <br /> Proposed Use of Building Contract Price of Work <br /> HT:A £ c 0 A Z0C-743-�C/l6 <br /> Square Footage(If residential new construction,remodel or addition) Contact Person/Contact Number/Email <br /> Number of devices(If low voltage) <br /> Description of Work to Be Done: LA 10 6-A^4n,JE 5 IEn t' r-ce TO i-I uE 40.160S <br /> 14&C 7 r—%; f_GTriU"L Oh/ IL 11 TH SL' 000 -Y <br /> 4T- 101#00 Art <br /> FEE <br /> CITY OF EVERETT LOCAL SALES TAX CODE'S 7105 I �. <br /> I hereby certify that I have mad and examined this application and know the some to be true and l <br /> correct. Art provisions of laws and ordinances governing this type of work will be completed -- - <br /> whether specified herein or not. The granting of a permit does not presume to give authority to PERMIT# <br /> violate or cancel the provisions of any other state or local law regulating construction or the ( <br /> E <br /> -r I �'I <br /> performance of constriction. That 1 am authorized by the owner of this property to perform the t i f L <br /> work for which application is made and I comply with the State Contractors Law 18.27 RCW and _ _- <br /> 296.200 WAC. <br /> Signature Jale <br /> REWS17001iea?010 <br />